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Home My WebLink AboutPermit Electrical 1995-3-22 . . The following project as submitted h.s the fo zonii!.g, and doss not requiro specific lend U' approval. 225 rJ.t Ul STREET !-.--v7 SPRINGFIELD, OREGON 97477 Zoninp t-L-- INSPECTION REQUEST: 726-3768oto-:]I;2_)1<" City Job Number OFFICE: 726-3759 ' , Aulhort!ad Signatura 3!\lllArlol1>tErE-F&E-SGHEDULE 1. LOCATION OF INSTALLATION (,.,0 te'J/'rt... J.i.,I..U PRo LEGAL DESCRIPTION /'/-Ll'3'-"? ~-/ ~ c:!? y'?~O -/ JOB DESCRIPTIj),N, RrmlJP n.. /~~ bW~.Ml"'~~ Permits are non-transferable and expire if work is not started within 180 days of issuance or if work is suspended for 180 days, 2. CONTRACTOR INSTALLATION ONLY Electrical Contractor ~~FA . / Address City Phone Supervisor License Number Expiration Date Constr Contr, Number Expiration Date Signature of Supervising Electrician Owners Name fJllfI'lO j- r-H-r-t! FrP ~I/;o 17 Address 6,0 I? IV fYt. filtH p e, City S1'4/~lC/nLJ Phone 7t'~-Dr!f'V "-'V7 _((?~ _ ~,'(Ic OIINER INSTALLATION /C 0 ( () 11 V~/ The installation is being made on E. property I own which is not intended for sale, lease or rent. Owners Signature: ~r 1Ze--C:- ~ ----------------------------~-------- DATE: 3' -":!l '2.. -~ ,s. l\r,""'.lrl iI: / ~ ,-;'f' RECEIVED BY: . ~ ~ -.o ~ . ELECTRICAL PERMIT APPLICATION q~t!>..:::?'?&:> BELOV A. New Residential-Single or Multi-Family per dwelling Service Included: uni t. Items Cost Sum 1000 sq.ft. or less $ 85.00 Each additional 500 sq. ft or portion thereof $ 15.00 Each Manuf'd Home or ModularD",elling Service or Feeder $ 40.00 B. Services or Feeders Installation, Alterations or Relocation: 200 amps or less $ 50.00 201 amps to 400 amps $ 60.00 401 amps to, 600 amps $100.00 601 amps to 1000 amps $130.00 Over 1000 amps/volts $300,00 Reconnect Only $ 40.00 C. Temporary Services or Feeders Installation, Alteration or Relocation 200 amps or less 201 amps to 400 amps Over 401 to 600 amps Over 600 amps or 1000 volts $ 40.00 $ 55.00 $ 80.00 see "B" above D. Branch Circuits .' New, Alteration or Extension Per Panel .,./"" $ 35.00 ~~- One Circuit Each Additional Circuit or with Servic~ or Feeder Permit 7. Y$ Miscellaneous (Service/feeder -Each installation Pump or irrigation Sign/Outline Lighting Limited Energy/Res Limited Energy/Comm '2.00 N,- not included) $ 40.00 $ 40.00 $ 20.00 $ 36.00 5. SUBTOTAL OF ABOVE <;1-9.. - 5% State Surcharge ,. 5'" - <_ Y.J - 3% Administrative Feel; f. ~~ TOTAL 5'7- -':1 ~ . . Permit #: 9_C)'::>-:::> '"?/? Address: -6 ,5"/"?,~ #c,:=- ~ . Issued by: ~~ _ Date: -;;:'-2"2 ~ ~ '// n Statement: Information Notice to Property Owners About Construction Responsibilities Note: Oregon Law. ORS 701,055(4), requires residential construction permit appli. cants who are not registered with the Construction Contractors Board to sign the following statement before a building permit can be issued, This statement is required for residential building, electrical, mechanical, and plumbing permits, Licensed architect and engineer applicants. exempt from registration under ORS 701,010(7), need not submit this statement, This statement will be filed with the permit, Fill in the appropriate blanks and initial boxes I and 2, and either box 3A or 3B: o D I, I own, reside in, or will reside in the completed structure, 2, I understand that I must register as a construction contractor if the structure is sold or offered for sale before or upon completion, D 3A. My general contractor is (Name) Contractor regis, # I will instruct my general contractor that all subcontractors who work on the structure must be fegistered with the Construction Contractors Board, OR ~ 3B, I will be my own general contractor, If I hire subcontractors, I will hire only subcontractors registered with the Construction Contractors Board, If I change my mind and hire a general contractor, I will contract with a contractor who is registered with the CCB and will immediately notify the office issuing this building permit of the name of the contractor. I hereby certify that the above information is correct and that I have read and do understand the Information Notice to Property Owners about Construction Responsibilities on the reverse side of this form. ff?-~.r: ~ (Signature of permit applicant) 7-1.~ - 9.1'- (Date) (White copy to issuing agency permit file, pink copy to applicant) . . .- ....,. ][n11O~maiilOi'i ~o~ice ilO lP~opei'liv OWU1Je~S Aro~L!~ C~$~[j'u~~ilOU1J ~iSSpOU1JSoroDmDiSs , , Note: This Information Notice to Property Owners about Construction Responsibilities was developed by the l.:onsiruction Contractors Board in accordance with ORS 701,055(5), If you are acting as your own contractor to construct a new home or make a substantial improvement to an existing structure, you can prevent many problems by being aware of the following responsibilities and areas of concern. EMPLOYER RESPONSIBILITIES: If you hire persons not registered with the Construction Contractors Board to do labor in constructing or assisting in the construction or improvement of a residential structure, you will, in most instances, be ruled to be an employer and the people you hire will be employees, As the employer, you must comply with the following: Oregon's withholding tax law: As an employer, you must withhold income taxes from emp)oyee wages at the time employees are paid, You will be liable for the tax payments even if you don't actually withhold the tax from your employees, For more information, call the Oregon Dept. of Revenue at 945.8091. Unemployment insurance tax: As an employer, you are required to pay a tax for unemployment insurance purposes on the wages of all employees. For more information, call the Oregon Employment Division at the Department of Human Resources at 378-3524. Workers' compensation insurance: As an employer, you are subject to the Oregon Workers' Compensation Law, and must obtain workers' compensation insurance for your employees, If you fail to obtain workers' compensation insurance, you may be subject to penalties and will be liable for all claim costs if one of your employees is injured on the job, For more information, call the Workers' Compensalion Division at the Department of Consumer and Business Services at 945-7888, U.S. Internal Revenue Service: As an employer, you must withhold federal income tax from employees' wages, You will be liable for the tax payment even if you didn't actually withhold the tax, For more information, call the Internal Revenue Service at 1-800-829.1040, OTHER RESPONSIBILITIES AND AREAS OF CONCERN: Code compliance: As the permit holder for this project, you are responsible for resolving any failure to meet code requirements that may be brought to your aUention through inspections, Liability and property damage insurance: Contact your insurance agent to see if you have adequate insurance coverage for accidents and omissions such as falling tools, paint overspray, water damage from pipe punctures, fire, or work that must be re-done, Time to supervise employees: Make sure you have sufficient time to supervise your employees, Expertise: Make sure you have the expertise to act as your own general contractor. to coordinate the work of rough-in and finish trades, and to notify building officials at the appropriate times so they can perform the required inspections. If you have additional questions, write or call the Construction Contractors Board (PO Box 14140, Salem, OR 97309-5052, 503/378-4621), The Board is located at 700 Summer St. NE Suite 300, in Salem, prop-own.pm4 1/94 . ATIACHMENT B1 . NO,9'So'Z.-"lD CITY OF SPRINGFIELD SYSTEMS DEVELOPMENT CHARGE WORKSHEET (COMMERCIAL & RESIDENTIAL) NAME OR COt~PANY: DAVID ~ IHE:.e...E:.'7A f:-I-LlCl'T' LOCATION' e,,"':>c> R\~slL 4\LLS D~\v'E- n o~?Ll; \ ~ - 049 CD DEVELOPMENT TYPE: Lv ~ - A-t>-c \ '\ \ b N BUILDING SIZE: lOT SIzE SQ. Ft. 1. SIORM nRATN~ " c-- =:> IMPERVIOUS SQ, FT, X $0,209 PER SQ, FT, -......... 2, S8NlIARY SFWFR.(ITY c:~'Z.-~ NO, OF PFU'S f X $43,26 PER PFU (See Reverse) ......... ------- 3, TRANSPORTATION NO OF UNITS X TRIP RATE X COST PER TRIP X X $436.19 X X $436.19 G-) '--- ~ $ X X $436.19 $ SUBTOTAL (ADD ITEMS 1.2, & 3) $ '?o?'- ~..... 4. SANITARY SFWFR-MWtlC NO, OF PFU'S x $17.19 PER PFU + $10 MWMC ADMIN,FEE $ (Use PFU Total From Item 2 Above) MWMC CREDIT IF APPLICABLE (SEE REVERSE) IQIAI -MWM( SDC; SUBTOTAL (ADD ITEMS 1.2.3 & 4) $ U -0-:- ) $ ~O'2.-e:,"2. 5, ADMINISTATTVF FFFS BASE CHARGE (SUBTOTAL ABOVE) X .05 Cl~0) "- --- ~i~;-,L~ l ~~~. ?~. SDC Coordinator Date: ?/rL! /'1S TOTAl SDC $ ~I"'''~ B2.SDC ' FIXTURE UNIT CALCULA iMi)N TABLE: Number of New Fixtur.unit Equivalent =' Fixture Units' (NOTE: For remodels; calculate only tl~ additional fixtures) NUMBER OF UNIT FIXTURE " FIXTURE TYPE NEW FIXTURES EOUIVALENT UNITS Bathtub.,...,..",.,....,...."""..",........,.".,.,..,.,.,.".,......., , Drinking Fountain..................................................... Floor Drain",..,.."""..""",."""""""."""".."" ,.".".,,' Interceptors For Grease/OiI/Solids/Etc................, Interceptors 'For Sandi Auto W ash/Etc......: ..,......., Laundry T ub/Clotheswasher""..,.."...",.. ,.."", ,. ,.,.., Clotheswasher', 3 'Or More.......,~.....................,...,.,' Mobile Home Park Trap (1 Per Trailer),................. Receptor For RefrigeratorlWater Station/Etc....,... Receptor For Commercial Sink/Dishwasher/Etc.. Shower, Single Stall..........,...........,.......................... Shower, Gang............."....... ,........... ,........... .......,.... Sink: Bar, Commercial, Residential Kitchen........................ Urinal, StaIlIWall"....," ,., .,.,... ,........, ,. .... ,.... ,........ .;.... Wash Basin/Lavatory, Single".,....,.".",.,....,...,....,., Toilet, Public Installation,."......"..,...,..,.,................ Toilet, Private............., ,."",..""., ,. ,...,.. ,. ,.,.." ,. ,.:... Miscellaneous: 2 1 2 3 6 2 ,6 6 1 3 2 1/Head 2 2 1 6 4 z., 4 TOTAL FIXTURE UNITS = -, CREDIT CALCULATION TABLE: Based on assessed value, If improvements occurred after annexation date in table, calculate credits separates, Year Annexed Rate per $1,000 Assessed Value Year Annexed Rate per $1,000 Assessed Value l I 1979 or before 1980 ,1981 1982 1983 1984 1985 $3.46 3,38 3.32 3,21 3.06 2.92 2,73 1985 1986 1987 1988 1989 1990 1991 1993 $2.46 2,14 1,77 1.37 0.97 0,61 0.44 0,15 Improvement (if after annexation date) X $ (Rate X Assessed Value) X $ (Rate X Assessed Value) = Credit for Parcel or land Only If Applicable CREDIT TOTAL = $